羟乙基淀粉对肾移植受体肾功能影响优秀案例课件

1、羟乙基淀粉对肾移植受体肾功能影响羟乙基淀粉对肾移植受体肾功能影响（优选）羟乙基淀粉对肾移植受体肾功能影响（优选）羟乙基淀粉对肾移植受体肾功能影响渗透性肾病因静脉滴注高渗溶液引起肾小管细胞肿胀、空泡样变性称为渗透性肾病 osmotic-nephrosis，临床可表现为蛋白尿、血尿、肾功能损害，严重者发生急性肾衰竭.渗透性肾病因静脉滴注高渗溶液引起肾小管细胞肿胀、羟乙基淀粉对肾移植受体肾功能影响优秀案例课件 一般认为大剂量高渗液引起肾小管上皮细胞肿胀，空泡样变致肾小管闭塞引起渗透性肾病，可能与肾小管肾小球反馈机理以及高浓度高渗液引起肾血管痉挛有关。 一般认为大剂量高渗液引起肾小管上皮细胞肿胀，空泡

2、样变致Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P Coriat THE LANCET ，Vol 348 December 14, 1996Effect of hydroxyethylstarch iBackground Hydroxyethylstarch used as a plasmavolume expan

3、der in braindead kidney donors has been suggested to induce osmoticnephrosislike lesions. Background HydroxyethylstarMethods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded. Methods 52 patients who haWe saw a higher frequency of extrarenal

4、haemodialysis during the first 8 days, and increased serum creatinine during the first 10 days.In the hydroxyethylstarchgelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion, and afterwards received modified fluid gelatin.Multiple organ procurement was

5、 not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).Also, there was no significant difference in serum creatinine level before organ procurement (meanSD) 84 38 mol/L in the hydroxye

6、thylstarch group versus 89 29 mol/L in the gelatinonly group.Mostly proximal but also distal tubules were affected.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded.69 other braindead patients were prospectively included over 18 month

7、s and randomised into two groups.Mostly proximal but also distal tubules were affected.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded.Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant rec

8、ipientsIn the hydroxyethylstarchgelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion, and afterwards received modified fluid gelatin.Multiple organ procurement was not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), canc

9、er (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).Nine renalbiopsy specimens were examined (six in the gelatinonly group).Serum creatinine concentrations were significantly lower in the gelatinonly group than in the other group (p=0009) .羟乙基淀粉致急性肾功能衰竭的病理特征During the

10、first 8 days after transplantation, nine of 27 (33%) patients required extrarenal haemodialysis in the hydroxyethylstarchgelatin group compared with one of 20 (5%) in the gelatinonly group (p=0029) .All organ donors received fluid expansion according to transoesophageal echographic data.THE LANCET ，

11、Vol 348 December 14, 199669 other braindead patients were prospectively included over 18 months and randomised into two groups.We saw a higher frequency of eAmong these 69, multiple organs were obtained in 29, including kidneys in 27 cases. Multiple organ procurement was not possible in 40 patients

12、because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).Among these 69, multiple oWe therefore studied 27 organ donors(hydroxyethylstarchgelatin 15,gelatinonly 12) .We therefore studied 27 organ In the hydroxyethyl

13、starchgelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion, and afterwards received modified fluid gelatin. In the hydroxyethylstarchgelatIn the gelatinonly group, patients received only modified fluid gelatin as colloid plasmavolume expander.In the g

14、elatinonly group, patiAll organ donors received fluid expansion according to transoesophageal echographic data. Hypovolaemia was diagnosed when leftventricular enddiastolic area (LVEDa) was below 55 cm 2 /m 2 .All organ donors received Catecholamine doses were adjusted to obtain a mean arterial pres

15、sure between 60 and 100 mm Hg, after fluid loading if necessary. Catecholamine doses were aNo adverse reaction to either expander was observed.Hypovolaemia was diagnosed when leftventricular enddiastolic area (LVEDa) was below 55 cm 2 /m 2 .During the first 8 days after transplantation, nine of 27 (

16、33%) patients required extrarenal haemodialysis in the hydroxyethylstarchgelatin group compared with one of 20 (5%) in the gelatinonly group (p=0029) .No adverse reaction to either expander was observed.M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P Coriat（优选）羟乙基淀粉对肾移植受体肾功能影响Multiple or

17、gan procurement was not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients（优选）羟乙

18、基淀粉对肾移植受体肾功能影响Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipientsAlso, there was no significant difference in serum creatinine level before organ procurement (meanSD) 84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonl

19、y group.因静脉滴注高渗溶液引起肾小管细胞肿胀、M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P CoriatEffect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipientsNo adverse reaction to either expander was observed.Findings There were no significant differences in t

20、he characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients) .羟乙基淀粉对肾移植受体肾功能影响In the hydroxyethylstarchgelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion, and afterwa

21、rds received modified fluid gelatin.Multiple organ procurement was not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).丁尧海 张爱平 王艳侠 涂晓文 张颖玮Findings There were no significant differenc

22、es in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients) . No adverse reaction to eit羟乙基淀粉对肾移植受体肾功能影响优秀案例课件羟乙基淀粉对肾移植受体肾功能影响优秀案例课件 No adverse reaction to either expander was observed. Also, there was no sign

23、ificant difference in serum creatinine level before organ procurement (meanSD) 84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonly group. No adverse reaction to eiDuring the first 8 days after transplantation, nine of 27 (33%) patients required extrarenal haemodialysis

24、in the hydroxyethylstarchgelatin group compared with one of 20 (5%) in the gelatinonly group (p=0029) . During the first 8 days after Serum creatinine concentrations were significantly lower in the gelatinonly group than in the other group (p=0009) . 10 days after transplantation, mean (SD) serum cr

25、eatinine was, respectively, 145 (70) and 312 (259) mol/L.Serum creatinine concentration羟乙基淀粉对肾移植受体肾功能影响优秀案例课件 Nine renalbiopsy specimens were examined (six in the gelatinonly group). All three specimens in the hydroxyethylstarchgelatin group had osmoticnephrosislike lesions in the tubules. Nine rena

26、lbiopsy specimens we羟乙基淀粉对肾移植受体肾功能影响优秀案例课件In this prospective randomised study we found that administration of hydroxyethylstarch to braindead kidney donors worsened the prognosis of renal transplantation. In this prospective randomiWe saw a higher frequency of extrarenal haemodialysis during the fi

27、rst 8 days, and increased serum creatinine during the first 10 days.We saw a higher frequency of e The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in the hydroxyethylstarchgelatin group. The renal biopsies in nine kiMostly proximal but also distal tubules were a

28、ffected. These lesions were found in kidneytransplant biopsy specimens as long as 2 years after transplantation (data from ChL), which suggests a thesaurisoma mechanism.Mostly proximal but also diWe therefore studied 27 organ donors(hydroxyethylstarchgelatin 15,gelatinonly 12) .Mostly proximal but a

29、lso distal tubules were affected.Mostly proximal but also distal tubules were affected.Nine renalbiopsy specimens were examined (six in the gelatinonly group).We saw a higher frequency of extrarenal haemodialysis during the first 8 days, and increased serum creatinine during the first 10 days.THE LA

30、NCET ，Vol 348 December 14, 1996The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in the hydroxyethylstarchgelatin group.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded.羟乙基淀粉对肾移植受体肾功能影响Findings The

31、re were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients) .（优选）羟乙基淀粉对肾移植受体肾功能影响Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant re

32、cipientsIn the hydroxyethylstarchgelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion, and afterwards received modified fluid gelatin.（优选）羟乙基淀粉对肾移植受体肾功能影响Nine renalbiopsy specimens were examined (six in the gelatinonly group).Multiple organ procuremen

33、t was not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2).羟乙基淀粉对肾移植受体肾功能影响因静脉滴注高渗溶液引起肾小管细胞肿胀、The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in

34、the hydroxyethylstarchgelatin group.丁尧海 张爱平 王艳侠 涂晓文 张颖玮Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipientsInterpretation These data suggest that hydroxyethylstarch used as a plasmavolume expander in braindead donors impairs immediate renal functio

35、n in kidneytransplant recipients.We therefore studied 27 organ M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P Coriat因静脉滴注高渗溶液引起肾小管细胞肿胀、The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in the hydroxyethylstarchgelatin group.Findings There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients) .No adverse reaction to either expander was observed.